Primary Care

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Assessing a patient's willingness to adopt dietary and lifestyle changes is the first step toward sustained weight loss

The majority of adults in the United States (55 percent) are overweight, and two-thirds of those with weight problems are likely to also have diabetes, heart disease, high blood pressure, or another obesity-related condition. Yet few obese adults seen by primary care physicians receive effective treatment. Doctors, constrained by time and not reimbursed for obesity counseling, often can do little more than tell their patients to "eat less and exercise more."

A recent study offers suggestions on how doctors can help their patients lose weight over time. It shows that patients are receptive to losing weight under their doctor's supervision, but that patients vary in their readiness to adopt specific weight-loss behaviors. For instance, some patients may be ready to increase their exercise but not to reduce the fat in their diet. Others may be ready to eat more fruits and vegetables but not to eat smaller portions of food. If doctors can identify which behaviors patients are willing to change, they can begin an effective weight-loss program, notes Everett Logue, Ph.D., of Summa Health System.

In a study supported by the Agency for Healthcare Research and Quality (HS08803), Dr. Logue and colleagues studied the feasibility of using an obesity intervention based on the transtheoretical model of behavior change and chronic disease care. The rationale for the model was that treatment for obesity would be more effective if it could be tailored to the patient's readiness and ability to change target behaviors. The researchers used the model to construct a questionnaire, which they administered to 284 obese family practice patients to examine their receptivity (stage of change) to six target behaviors: dietary fat, portion control, vegetable intake, fruit intake, usual physical activity, and planned exercise.

Patients answered questions about their readiness to change each of these behaviors with statements ranging from "not thinking about changing" to "actively making the change for more than 6 months." "Preparation" (almost ready to change) was the most frequently reported stage of change. However, patients in the preparation stage for one target behavior often were not in that stage for other target behaviors. These profiles indicate which behavior(s) a patient is ready to work on at any given clinical visit and can be used by doctors to get the "right" weight-loss advice to the right obese patients at the right time. The challenge is to find the time and resources to support these programs in day-to-day clinical practice, notes Dr. Logue.

See "Obesity management in primary care: Assessment of readiness to change among 284 family practice patients," by Dr. Logue, Karen Sutton, Ph.D., David Jarjoura, Ph.D., and William Smucker, M.D., in the May-June 2000 Journal of the American Board of Family Practice 13, pp. 164-171.